Monthly Archives: July 2026

Anesthesiology, Print Release

PUBLISHED: Neuraxial Ultrasound and Epidural Blood Patch for Post-dural Puncture Headache

Neuraxial Ultrasound and Epidural Blood Patch for Post-dural Puncture Headache
Fatine Karkri, MD; Lauren Blake, MD; Brendan Carvalho, MBBCh, FRCA, MDCH, FASA
Stanford University School of Medicine

This video demonstrates a stepwise technique for performing an autologous epidural blood patch (EBP) to treat post-dural puncture headache (PDPH). The video covers identification of the target interspace, skin cleaning, local anesthesia infiltration, epidural needle placement using loss-of-resistance technique, aseptic collection of autologous blood, controlled injection into the epidural space, and immediate assessment of EBP effect. Indications, contraindications, expected immediate responses, and troubleshooting (including repeat EBP and alternative interventions) are discussed. The technique shown aims to maximize efficacy and enhance safety, and is applicable to PDPH after dural puncture from spinal anesthesia or inadvertent dural puncture during epidural placement.

General Surgery, Print Release

PUBLISHED: Robotic-Assisted Transcystic Endoscopic Common Bile Duct Exploration

Robotic-Assisted Transcystic Endoscopic Common Bile Duct Exploration
Marc Mankarious, MD1; Benjamin S. C. Fung, MD, FRCSC2; Joshua S. Winder, MD1
1Penn State Health Milton S. Hershey Medical Center
2North York General Hospital, University of Toronto

Choledocholithiasis complicates cholecystectomy in 10–15% of patients. In individuals with prior Roux-en-Y gastric bypass (RYGB), altered foregut anatomy renders traditional endoscopic retrograde cholangiopancreatography (ERCP) technically challenging or unsuccessful. This report details the use of robotic-assisted transcystic endoscopic common bile duct exploration (TCBDE) in a patient with RYGB and choledocholithiasis. For patients with surgically altered anatomy and urgent need for stone clearance, robotic TCBDE represents a safe, cost-effective, single-stage alternative to two-stage approaches, effectively bypassing the anatomical limitations imposed by RYGB.

Print Release, Surgical Technology

PUBLISHED: How to Drape a C-Arm

How to Drape a C-Arm
Cindy Fletcher, M.Ed., CST
North Shore Community College, Danvers, MA

When intraoperative imaging is needed, a mobile x-ray machine must be used by a radiologic technologist (RT) to take the image. A C-arm portable imaging machine, so called because its shape resembles the letter “C”, is widely used in contemporary surgical and interventional procedures for this purpose, and its proper draping is essential for maintaining sterile field integrity. This educational video demonstrates how to receive a C-arm drape onto the sterile field, how to prepare it for use, and how to place and secure it around the C-arm using sterile technique to protect patient safety. This video was filmed in an academic setting and is intended for perioperative trainees and staff.

Pediatrics, Print Release, Vascular Surgery

PUBLISHED: Pediatric Ultrasound-Guided Internal Jugular Central Venous Catheter (CVC) Insertion for Chemotherapy Delivery

Pediatric Ultrasound-Guided Internal Jugular Central Venous Catheter (CVC) Insertion for Chemotherapy Delivery
Yuki Noguchi, MD, PhD; Kohga Masuda, MD, PhD; Shohei Hiwatashi, MD, PhD; Satoshi Umeda, MD, PhD; Masahiro Zenitani, MD, PhD; Keigo Nara, MD, PhD
Osaka Women’s and Children’s Hospital

Central venous catheterization is a commonly performed procedure in pediatric surgery, requiring both appropriate device selection and meticulous technique to ensure long-term function and minimal complications. This article reports the technical considerations of tunneled central venous catheter placement in a pediatric patient with neuroblastoma.

A two-year and four-month-old boy with neuroblastoma required central venous access for chemotherapy. Preoperative evaluation confirmed patency of the right internal jugular vein and other central veins. A cuffed tunneled external catheter was selected, as it allows continuous access without repeated needle puncture and is suitable for multi-lumen use, including drug administration and blood sampling. Although routine blood sampling via central venous catheters is not generally recommended, our experience suggests that the associated risks are infrequent and clinically acceptable.

The catheter was inserted via the right internal jugular vein. The anterior chest wall exit site was determined using anatomical landmarks, specifically the triangle formed by the sternal notch, right acromion, and right nipple, with the entry point positioned near its center. Key technical considerations included creation of a broad, curved subcutaneous tunnel to prevent catheter kinking, secure fixation using a cuff with additional circumferential suturing to reduce early dislodgement, and accurate tip positioning at the junction of the superior vena cava and right atrium. In practice, the optimal tip location was estimated as approximately 1–2 vertebral body units below the carina. Careful hemostasis and postoperative compression were performed to minimize hematoma formation.

General Surgery, Pediatrics, Print Release

PUBLISHED: Laparoscopic Percutaneous Extraperitoneal Closure (LPEC) for an Inguinal Hernia with Concomitant Umbilical Hernia Repair in a Pediatric Male

Laparoscopic Percutaneous Extraperitoneal Closure (LPEC) for an Inguinal Hernia with Concomitant Umbilical Hernia Repair in a Pediatric Male
Yuki Noguchi, MD, PhD; Kohga Masuda, MD, PhD; Shohei Hiwatashi, MD, PhD; Satoshi Umeda, MD, PhD; Masahiro Zenitani, MD, PhD; Keigo Nara, MD, PhD
Osaka Women’s and Children’s Hospital

This report describes the surgical management of a one-year eight-month-old boy with concurrent right inguinal and umbilical hernias, highlighting both clinical rationale and operative technique. Pediatric inguinal hernias are typically indirect and rarely resolve spontaneously, carrying a persistent risk of incarceration that necessitates surgical repair once diagnosed.

Ultrasonography confirmed a right indirect inguinal hernia with reducible protrusion of the small intestine through a patent processus vaginalis. Although the umbilical hernia showed partial improvement with external compression, the inguinal hernia was unlikely to resolve spontaneously. Therefore, laparoscopic percutaneous extraperitoneal closure (LPEC) was planned, with simultaneous umbilical hernia repair.

LPEC enables high ligation of the hernia sac with minimal dissection and excellent visualization. In male patients, careful technique is required to avoid injury to the spermatic vessels and vas deferens. Tip rotation should be avoided; instead, the needle tip is advanced perpendicularly across these structures at the shortest possible distance to minimize dissection. Gentle manipulation facilitates safe passage, and confirmation that critical structures are not entrapped within the suture loop is essential before ligation. Caudal traction of the testis may further reduce the risk of iatrogenic cryptorchidism.